A review of literature on modern parenteral nutrition.

Appropriate nutritional support is the standard of care for hospitalized patients. Total parenteral nutrition has evolved as a distinct therapeutic reality within the past decade for patients with appropriate indications including but not limited to non/dysfunction of the gastrointestinal tract. Starvation/malnutrition historically associated with prolonged hospital stay and protracted illness course can be somewhat addressed successfully. Though it is a well-established fact that current TPN techniques can be both safe and effective if used with due caution, the prevention and awareness of potential complications must be considered. Changes in technique are to be anticipated as advancement of knowledge and improvement and innovation in materials ensues. The current effectiveness and safety of TPN, particularly in comparison to enteral feeding and the clinical situations most appropriate for nutrition support have been the topic of ongoing discussion. Innovative strategies such as supplementation of TPN with medium-chain triglycerides, glutamine or branched-chain amino acids have been compared with standard treatments. Increasing efforts are being made to mitigate the adverse effects associated with TPN such as hyperglycaemia, central venous catheter infection, and hepatic dysfunction. This review focuses on these issues as addressed by the recent literature.

An elucidatory review of the association between thyroid disorders and diabetes.

Thyroid disease and Diabetes (type 1 and type 2) are known to be pathophysiologically associated. The implications of the associations have clinically relevant implications for insulin sensitivity and adequate management requirements. Interconnectedness of common signalling pathways forms the pathophysiological basis of this association. In the case of type 1 diabetes and autoimmune thyroid disease, linked genetic susceptibilities may be involved. Interactions between thyroid hormone and the basal mechanisms controlling appetite, energy expenditure and insulin sensitivity regulation / secretion governance are also significant to understand. A clearer understanding of the interactions between diabetes mellitus and thyroid hormones has the potential to assist in optimization of treatment in a select group of diabetic patients.